Provider Demographics
NPI:1124191044
Name:ROHARDT, ANDREA EVELYN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:EVELYN
Last Name:ROHARDT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:HAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:45 COUNTY ST
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-4107
Mailing Address - Country:US
Mailing Address - Phone:781-320-0174
Mailing Address - Fax:
Practice Address - Street 1:12 POST OFFICE SQUARE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109
Practice Address - Country:US
Practice Address - Phone:617-542-8808
Practice Address - Fax:617-451-1912
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA169021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice